Program Coordinator - Community Health Worker

EOE Statement
We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.
Description
Purpose:
To provide a structured approach for community health workers to support participants engaging in RBPM in the Pressure Check Study, helping them to adhere to self-monitoring and attendance to blood pressure visits. In addition, CHWs will identify, assess, and refer and follow-up when indicated for participants facing social barriers such as: transportation, medical access, utilities, technology access and literacy, food insecurity, and housing instability.
1. Role of a Community Health Worker (specialized in hypertension)
CHWs are responsible for:

1. Reinforcing BP monitoring practices at home.

1. Supporting patients with appointment reminders and telehealth set-up.

1. Providing follow-up after medical appointments to address medication, lifestyle goals, and future appointments.

1.1. Morning Huddle:

• Participate in a weekly huddle with the team f health advocates, clinicians, and supervisor. Review the week's priorities, discuss any urgent needs, and align team goals.

• Share any updates frm previous days, including unresolved issues or successes.

• Review reprts in RedCap to make sure data entry is complete and correct

• Identify patients wh need reminder calls for Pressure Check medical appointments, follow up calls after completed medical appointments, and follow up on SDOH or any open-to do

1.2. Reminder Calls/Text:

• Make reminder calls t patients scheduled for upcoming Pressure Check medical appointments.

• Make reminder calls befre Pressure Check Study Visits

• Make text check-ins if the participant is nt measuring BP regularly (2 times a day, 3x a week)

During the call, ask about:

• Transprtation: Any barriers with transportation (if in-person visit)

• Appintment: Remind patient of (date, time, location) and confirm that the patient is prepared for their appointment and address any last-minute concerns.

• Technlogy: appointment inquire about connectivity issues or concerns with schedules.

• Dcument all communications in RedCap using the Cntact Log and schedule any necessary fllow up call.

• If any issues, questions or concerns arise during the call, communicate with the clinical team via EPIC as needed (close the loop).

1.3. SDOH Check-Ins:

• During reminder calls r follow up calls for RBPM appts, check on any outstanding SDOH needs.

• Cnduct a formal check-in at 1 month to make sure the participant's Stel Hub is working properly, they are regularly measuring their blood pressure and that priority 1 SDOH need has started to be addressed.

• At 3 mnths, ask the patient if the resources provided have been helpful and if there have been any outcomes.

• At 6 mnths, contact the participant. Notify them of their graduation from the study and close out any resolved needs and document updates in Redcap.

• If new needs arise r existing needs are unmet, communicate with supervisor/coordinator to explore additional resources.

1.4. Follow up Calls:

• Losely follow same structure of RBPM follow-up, have biweekly check-ins during the first 3 months of their study participation, reduce to once-a-month check-ins until 6 months of enrollment has been completed.

• After 3 n contacts/no shows to appointments or phone calls, attempts will no longer be made.

• If the clinical team also cannot reach participant after 3 no contacts/no shows, please discontinue EPIC/Stel connection.

• Study staff should still attempt to reach participant for 6-month follow-up appt.

• Cnduct follow-up calls 48 hours after every participant's clinical appointment (business days). Purpose: Address any clinical questions the patient may have, such as those about care plan and or prescriptions

• Communicate any clinical questions back to the clinical team for further information.

• Close the loop on any open questions, especially regarding new treatment or prescriptions.

1.5. Ensure all updates are recorded in RedCap

• Track all patient cmmunications, including the timing of appointments in RedCap RBPM appt lg.

• Update the status f follow ups, appointments, and SDOH needs in SDOH tracker.

• Schedule and dcument future reminder calls, letting the patient know when the next call will be made and what the next steps are.

1.6. End of Day Review:

• Review ur day's work, ensuring all tasks have been documented and follow ups are scheduled.

• Cmmunicate any unresolved issues or resource needs to your supervisor

• Prepare fr the next day by reviewing upcoming tasks and scheduling any necessary calls.

• Wrk on coverage with supervisor if needed during time off.

1.7. 6-Month Follow-up:

• Cntact the participant 1 week before the 6-month follow-up appt and remind them as they approach the end of this period.

Discuss any ongoing SDOH needs and plan prior to end of intervention arm.
Shift
-not applicable-
Work Site
AAMWA
About the Organization
On-Site Guideline
On-Site
Full-Time/Part-Time
Full-Time
This position is currently accepting applications.